The Skeleton in the Closet: Harvesting a Skeletonized IMA
There is a considerable amount of data that using more than one arterial graft provides a survival advantage for patients undergoing coronary bypass operations. The Society of Thoracic Surgeons has a set of official guidelines for the use of arterial grafts which include the following recommendations:
- Internal mammary arteries (IMA’s) should be used to bypass the left anterior descending (LAD) artery when bypass of the LAD is indicated.
- As an adjunct to left internal mammary artery (LIMA), a second arterial graft (right IMA or radial artery [RA]) should be considered in appropriate patients.
- Use of bilateral IMA’s (BIMA’s) should be considered in patients who do not have an excessive risk of sternal complications.
- To reduce the risk of sternal infection with bilateral IMA’s, skeletonized grafts should be considered, smoking cessation is recommended, glycemic control should be considered, and enhanced sternal stabilization may be considered.
- Use of arterial grafts should be a part of the discussion of the heart team in determining the optimal approach for each patient.
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